Long-term Aesthetic Results Research Articles

Breast-conserving therapy can be offered to women with prior breast augmentation

IntroductionBreast cancer in women with cosmetic breast implants is increasingly common. Over the past decade, there has been a push for mastectomy and reconstruction in these patients, based on a fear of poor aesthetic results from small breast volume, and radiation-induced capsular contracture. At the Paris Breast Centre, augmented women routinely undergo lumpectomy with whole-breast irradiation (BCT). Materials and methodsA consecutive cohort of 50 augmented women, who had attempted BCT for early breast cancer at our institution between 2003 and 2018, were retrospectively identified. Post-treatment complications, oncologic outcomes, capsular contracture rates, long-term cosmetic outcomes, and patient-reported outcomes were evaluated. ResultsThe median follow-up was 51 months. Margins were involved in 7 women (14%); 4 of whom underwent successful re-excision, and 3 had a mastectomy, for an early mastectomy rate of 6%. There were no early complications, nor cases of early implant loss. Long-term aesthetic results were evaluated using our 5-point scale: An excellent (5), or good (4) result was obtained in 68%. Significant capsular contracture (Baker grade 3 or 4) developed in 34%, of which, 5 women underwent capsulotomy and fat grafting; 4 of 5 downstaging their Baker grade. The estimated 5-year local recurrence rate was 2.3%. Ninety-five percent of participants would recommend BCT to augmented women. ConclusionBCT is feasible and safe in augmented women with good long-term aesthetic results, and should be considered to avoid unnecessary mastectomy.

Abstract QS36: Spatial Fidelity Of Microvascular Perforating Vessels As Perceived By Augmented Reality Holographic Projections

Purpose: Breast reconstruction using free-tissue transfer yields improved long-term aesthetic results as reported by patients, but requires increased resources of practitioners and hospital systems. Much of the complexity of microvascular reconstruction can be attributed to flap harvest, as dissection must account for anatomic variability, and is guided at best by ancillary imaging modalities which must be extrapolated to the patient on the table. Augmented reality affords the opportunity to superimpose relevant imaging on a surgeon’s native field of view. This potentially allows integration of imaging in real-time to better guide flap selection and facilitate dissection. We aimed to assess the spatial fidelity of key anatomic landmarks on augmented-reality projections compared to 3D printed anatomic simulacrum models formatted from CT-Angiography (CTA) imaging in patients undergoing autologous breast reconstruction. Methods: 3D-printed composite models of rectus abdominal muscles and associated Deep Inferior Epigastric Arteries (DIEP) with perforating vessels were fabricated from CTA data from de-identified patients. The corresponding CTA data was similarly formatted to be used on the Microsoft Hololens with the Microsoft Mixed Reality Toolkit 2.01 and Unity 2019.2.4 Visual Studio. Coordinates were measured using the OptiTrack Flex 13 Motion tracking system. The 3D printed models were zeroed to an arbitrary reference point maintained for each set specimen. Established anatomic points including upper and lower borders of the umbilicus, superficial location of perforating vessels, and corners of the model were initially measured. The Hololens projection was then superimposed using hand-gesture and voice commands onto the model, and set into place, ensuring immobile position despite translational movement of the headset. The model was then removed, and the corresponding anatomic reference points were recorded in triplicate from two separate vantages. Results: Five sets of 3D printed models and corresponding Hololens projections were measured. Absolute distance from left to right perforators were calculated from measurements of the model and the Hololens projection, from two vantages. Analysis of variance (ANOVA) were conducted on each group of measurements independently for each specimen. In two of the five specimens (#1 and #32), there was no significant difference in inter-perforator distance. The greatest discrepancy of inter-perforator distance between any projection and those measured on 3D models was 5.6 mm in specimen 21. Conclusions: Our data demonstrate that holographic projections can be used to accurately localize relevant three-dimensional structures extrapolated from CT imaging, on the scale of millimeters. Two of five models demonstrated no significant variability in perceived three-dimensional location of inter-perforator distance and, despite significant inter-group variability, Hololens projections were perceived within millimeters of the corresponding physical landmark. Augmented reality provides a potential paradigm shifting adjunct for intra-operative localization of perforating vessels in free-tissue flap harvest.

Evaluation of vertical ramus osteotomy for the surgical correction of unilateral mandibular posterior vertical insufficiency: Long-term follow-up results

PurposeUnilateral posterior vertical insufficiency (PVI) is a growth defect of the mandibular condyle that results in a facial asymmetry. Various surgical procedures can be used to elongate the hypoplastic ramus. The aim of this study was to evaluate long-term aesthetic and architectural outcomes of vertical ramus osteotomy (VRO) in patients with unilateral PVI. Materials and methodsPatients operated on with unilateral VRO were included in this retrospective study. Aesthetic and architectural parameters were evaluated on frontal photographs as well as on frontal and lateral cephalograms preoperatively, postoperatively, at 1-year and at the end of the follow-up. ResultsA total of 48 patients were analyzed. The aesthetic assessment revealed significant correction of the chin deviation (CD) and of the lip commissural line tilt after VRO (p1 = 0.0038 and p2 = 0.0067, respectively) with stable results. The architectural analysis revealed significant improvement in the maxillary and mandibular occlusal planes, as well as the chin deviation (p < 0.0001). A tendency to relapse was noted for the mandibular canting and the CD during the follow-up. VRO allowed for a mean mandibular lengthening of 8.39 mm (ranging from 2.5 to 14 mm). ConclusionVRO allows for immediate restoration of the symmetry of the lower third of the face in patients with unilateral PVI. A revisional procedure may be needed due to a tendency for the chin deviation to relapse.

Follow-Up Study: One-Step Salvage of Infected Prosthetic Breast Reconstructions Using Antibiotic-Impregnated Polymethylmethacrylate Plates and Concurrent Tissue Expander Exchange.

Periprosthetic infections represent major complications in breast reconstruction, frequently leading to expander-implant loss. No consensus regarding a management algorithm for attempted salvage currently exists. This study assessed outcomes of the authors' salvage protocol using an antibiotic-impregnated polymethylmethacrylate implant with expander device exchange. A retrospective chart review identified infected implant-based breast reconstruction cases treated between 2009 and 2017. Of 626 cases initially identified, a total of 62 cases had severe prosthetic infections, and underwent either prosthetic salvage (n = 45) or immediate explantation (n = 17). All the prosthetic salvage patients received intravenous antibiotics followed by surgical débridement, insertion of polymethylmethacrylate plates, device exchange, and postoperative antibiotics. After clinical resolution of infection, tissue expansion was performed, with the polymethylmethacrylate plates remaining in situ until exchanged for permanent implants. The authors' study demonstrated a primary infection clearance rate of 82.2 percent (n = 37). Compared to the traditional explantation group, a significantly higher percentage of the salvage patients completed final reconstruction (84.4 percent versus 35.3 percent; p < 0.001). Fewer patients abandoned reconstruction efforts after infection clearance (2.2 percent versus 58.8 percent; p < 0.001). The majority of cases (78.8 percent) that succeeded the salvage protocol ultimately received implant-based reconstruction; 62.5 percent that failed the salvage protocol still went on to receive autologous tissue reconstruction. Sustained local antibiotic delivery using polymethylmethacrylate implants and expander device exchange can successfully salvage an infected breast expander/implant. Compared with the traditional explantation approach, more patients complete final reconstruction. Other benefits include preserved skin envelope integrity and possibly improved long-term aesthetic outcomes. Therapeutic, III.

Modified Internal Mastopexy Technique in Muscle Splitting Biplane Breast Augmentation.

The technique of muscle splitting biplane breast augmentation associated with internal mastopexy to correct breast hypoplasia, ptosis and asymmetry was reported in 2014. The purpose of this article is to present recent modifications and results of this technique. Since 2016, 30 patients with breast hypoplasia associated with excessive or loose skin envelope or breast ptosis grade I have benefited from a new and improved technique of internal suture mastopexy combined with the muscle splitting biplane breast augmentation (muscle splitting biplane breast augmentation with internal mastopexy type II or MSBBA-IM2). Excellent long-term results have been obtained by using the muscle splitting biplane breast augmentation with internal mastopexy type II, which maintains a natural breast shape and a smooth transition between the soft tissue and implant in the upper pole by redraping the breast parenchyma both at the level of the upper pole and at the level of the lower pole of the breast. The new technique of muscle splitting biplane breast augmentation with internal mastopexy type II or MSBBA-IM2 offers improved long-term aesthetic results and is an effective alternative in selected patients requiring correction of breast hypoplasia associated with excessive or loose skin envelope or breast ptosis grade I. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Favorable long-term esthetic, functional, and sensory outcome and preferability of distal digital replantations

Background: To evaluate long-term esthetic, functional, and sensory outcome and preferability of distal digit replantations with respect to contralateral intact finger. Materials and Methods: A total of 63 single-or multi-digit clean cut amputations distal to distal interphalangeal joint (DIPJ) involving nail fold in 45 consecutive patients (mean 29 years, 26 males, 19 females) who underwent replantation surgery between 2010 and 2016 were included in this study. Esthetic outcome, functional, and sensory outcome were assessed in the postoperative 6 months, 1 year, and 3 years. Results: Single-digit amputation was noted in 34 patients including thumb (n = 9), index finger (n = 10), middle finger (n = 7), ring finger (n = 7), and little finger (n = 1). Multi-digit amputations were evident in 11 patients involving 2 fingers in five patients (index + middle in two patients, middle + ring in two patients, and thumb + index in one patient), 3 fingers in five patients (index + middle + ring in 4 patients and middle + ring + little in one patient), and 4 fingers in one patient (index + middle + ring + little). All patients were operated within the first 4 h of hospital admission. Postoperative 3-year outcome was excellent in 79.3% of operations, good in 14.2%, and acceptable in 6.3% of operations. None of the operations resulted in poor or very poor outcome and none of the patients had functional loss during the entire follow-up period. A very satisfactory sensory outcome with static two-point discrimination test findings of

Multidisciplinary long-term care and modern surgical treatment of congenital melanocytic nevi - recommendations by the CMN surgery network.

In recent years, our knowledge of congenital melanocytic nevi (CMN) has greatly expanded. This has led to a paradigm shift. The present article represents a commentary by an interdisciplinary group of physicians from German-speaking countries with extensive experience in long-term care and surgical treatment of children and adults with CMN (CMN surgery network, "Netzwerk Nävuschirurgie", NNC). The authors address aspects such as the indication for treatment as well as treatment planning and implementation under these new premises. Adequate counseling of parents on conservative and/or surgical management requires an interdisciplinary exchange among physicians and individualized planning of the intervention, which frequently involves a multi-stage procedure. Today, the long-term aesthetic outcome is at the center of any therapeutic endeavor, whereas melanoma prevention plays only a minor role. The premise of "removal at any cost" no longer holds. Potential treatment-related adverse effects (hospitalization, wound healing disorders, and others) must be carefully weighed against the prospects of a beneficial outcome. In this context, the use of dermabrasion in particular must be critically evaluated. At a meeting of the NNC in September 2018, its members agreed on a consensus-based position on dermabrasion, stating that the procedure frequently leads to impaired wound healing and cosmetically unfavorable or hypertrophic scarring. Moreover, dermabrasion is considered to be commonly associated with considerable repigmentation that usually occurs a number of years after the procedure. In addition, the NNC members saw no benefit in terms of melanoma prevention. In the future, physicians should therefore thoroughly caution about the potential risks and often limited cosmetic benefits of dermabrasion.

The K-Wire Fixation Technique for Endoscopic Brow Lift: A Long-Term Follow-Up.

Many techniques have been presented for fixation during endoscopic brow lift, but no singular technique has become dominant. The authors described a technique for fixation for endoscopic brow lift that is inexpensive, easy to use, and versatile and has minimal morbidity. The charts of 284 patients who underwent the K-wire fixation technique between December 1996 and September 2018 were reviewed. This technique employs a transcutaneous K-wire to hold the brow in position until tissue adhesion creates a lasting elevation of the brow. A total of 284 patients underwent K-wire fixation for endoscopic brow lifting. Two patients had hematomas and 5 patients (1.8%) required a second unilateral brow lift procedure. Long-term elevation of the brow was maintained in all patients. K-wire fixation for endoscopic brow lift is a simple, safe, and effective technique for fixation during endoscopic brow lifting that provides long-term aesthetic results.

A Novel Approach to Crooked Nose in Rhinoplasty: Asymmetric Level Osteotomy Combined With Unilateral Spreader Graft.

The crooked nose is certainly among the most difficult to treat deformities for rhinoplasty surgeons. This deformity is a complex problem because each structural nasal component can be effected and they may be asymmetric bilaterally. Despite the use of sophisticated techniques and an additional effort, unfortunately the long-term aesthetic results may not be perfect with some minor flaws. Here in this study, the authors introduce a new technique that is used to correct crooked nose deformity. Sixteen consecutive patients who underwent open approach rhinoplasty by the same senior author between January 2015 and January 2018 with the diagnosis of C-shaped, reverse C-shaped, and I-shaped crooked nose deformity were included. The authors performed low-to-low lateral osteotomy with transverse root osteotomy to concave side (wider side) and low-to-high osteotomy to convex side (narrower side) combined with a unilateral spreader graft to concave side. Frontal images were taken preoperatively and 6 months postoperatively to use for further assessments. The authors compared the preoperative deviation angle values at rhinion (RDA) and at nasal tip (tip deviation angle) with postoperative values. In the study group, RDA value showed significant decrease after surgery; the preoperative RDA value was 6.2° (1.66°-16.39°) and it was calculated as 2.44° (0.7°-5.77°) with P < 0.001 postoperatively. The changes at tip deviation angle were also significant (P < 0.001) and tip deviation was successfully decreased from a value of 5.08° (2.8°-10.62°) to 2.13° (0.5°-6.6°) postoperatively. In conclusion, this study offers a new and effective technique to correct crooked nose deformity that can be used safely with satisfying aesthetic results.

Laser treatment of epidermal nevi: A multicenter retrospective study with long-term follow-up

Patients with epidermal nevi strongly demand cosmetic improvement. Laser treatment appears appealing and is frequently used in clinical practice. Nevertheless, large series with long-term follow-up are missing, preventing definitive conclusions about its real benefit. To evaluate the long-term effectiveness and safety of lasers for epidermal nevi. Bicentric, retrospective, cohort study, including all patients treated with a laser for an epidermal nevus with more than a 1-year follow-up. Seventy patients were treated for different types of epidermal nevi, mostly with ablative lasers: 23 verrucous epidermal nevi, 16 nevi sebaceous, 26 Becker nevi, 2 inflammatory linear verrucous epidermal nevi, 1 smooth-muscle hamartoma, 1 rounded and velvety epidermal nevus, and 1 nevus lipomatosus superficialis. The follow-up period was a median of 37months (range, 12-127months). Better results, fewer recurrences, and higher patient satisfaction were noted in treatments for verrucous epidermal nevi than for nevi sebaceous. Q-switched lasers failed to show any degree of improvement in almost all patients with Becker nevus. The retrospective nature of the study. Ablative lasers can treat verrucous epidermal nevi with good long-term esthetic results but have limited long-term efficacy for nevus sebaceous. Q-switched lasers failed to improve Becker nevi.

Outcomes of prepectoral implant-based breast reconstruction with Braxon® acellular dermal matrix—a single-centre experience

Single-stage direct-to-implant reconstruction is the most common method of reconstruction in the UK after a mastectomy. Prepectoral implant placement with full implant coverage using acellular dermal matrix (ADM) is a relatively new technique. We report on long-term outcomes of prepectoral immediate breast reconstruction (IBR) using Braxon® ADM from a single institution. All patients operated for a mastectomy with IBR using Braxon® from January 2016 to March 2018 were included in the study. The demographic details, treatment details and short- and long-term outcomes were evaluated. Factors affecting complication rates were analysed. Patient-reported outcome measures were studied using BREAST-Q questionnaires. One hundred and sixteen reconstructions performed in 98 patients were included in the study. The median age was 50 years with a mean body mass index of 27.33 kg/m2. The median follow-up period was 440 days. The implant-related major complication rate was 17%, with an unplanned readmission rate of 22.4% and a return to theatre rate of 21.4%. Early complications were significantly higher in patients with node-positive disease. Delayed complications were seen in nine patients. The implant loss rate was 4.3%. The mean BREAST-Q scores were 78 for satisfaction with treatment and 64 for satisfaction with breast domains. The outcomes were comparable to reported national data. Prepectoral implant-based reconstruction with Braxon has comparable complication rates with good long-term aesthetic and patient-reported outcomes. Further studies with larger cohort and longer follow-up are needed. Level of Evidence—Level III, therapeutic study.

Lower lateral crural turnover flap combined with alar batten graft for the long-term result of the treatment of alar convexities.

Introduction:Concave lower lateral cartilages not only cause an esthetic defect but can also lead to external nasal valve insufficiency. The objective of this article is to analyze the combination of two well-known surgical techniques: turning over the alar cartilages as well as the addition of grafts in order to obtain satisfying esthetic and functional long term results.Materials and methods:From August 2016 to July 2018, 62 rhinoplasties, a combination of both primary and revision cases, were performed at the Rouen University Hospital in France. Six of these involved the correction of concave alar cartilages. The turnover technique alone or in combination with Batten grafts was performed.Results:Immediate and 3-months post-operative esthetic results using the turnover flap technique were satisfactory. Alar batten grafts were occasionally employed in order to maintain the newly positioned alar cartilages and avoid long-term contour depressions.Conclusion:The combination of these two techniques seems to be an interesting solution to maintain long-term esthetic results.

Therapeutic strategies for skin regeneration based on biomedical substitutes.

Regenerative medicine and tissue engineering (TE) have experienced significant advances in the development of in vitro engineered skin substitutes, either for replacement of lost tissue in skin injuries or for the generation of in vitro human skin models to research. However, currently available skin substitutes present different limitations such as expensive costs, abnormal skin microstructure and engraftment failure. Given these limitations, new technologies, based on advanced therapies and regenerative medicine, have been applied to develop skin substitutes with several pharmaceutical applications that include injectable cell suspensions, cell-spray devices, sheets or 3Dscaffolds for skin tissue regeneration and others. Clinical practice for skin injuries has evolved to incorporate these innovative applications to facilitate wound healing, improve the barrier function of the skin, prevent infections, manage pain and even to ameliorate long-term aesthetic results. In this article, we review current commercially available skin substitutes for clinical use, as well as the latest advances in biomedical and pharmaceutical applications used to design advanced therapies and medical products for wound healing and skin regeneration. We highlight the current progress in clinical trials for wound healing as well as the new technologies that are being developed and hold the potential to generate skin substitutes such as 3D bioprinting-based strategies.

PROMs following breast-conserving therapy for breast cancer: results from a prospective longitudinal monocentric study

Treatment of breast cancer includes many options and shared decision making is becoming standard practice. Within the context of treatment individualization, the omission of radiotherapy (RT) can be considered. It is thereby of great importance to correctly foresee the side effects attributed to RT. Data from longitudinal studies with contemporary techniques however are sparse. The purpose of the present study was to evaluate patient-reported outcome measures (PROMs) and long-term aesthetic outcome (AO) related to RT in the breast-conserving therapy (BCT) setting for breast cancer over time. Patients treated with BCT between April 2015 and April 2016 were prospectively included in the cohort. Evaluations were made at six time points: at baseline (before RT), during and at the end of RT, between 3 and 6months, 1year and 2years after RT. AO was scored by the patient and by the BCCT.core software. Further PROMs were measured with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30/-BR23 and the Body Image after Breast Cancer Questionnaire BIBCQ. Patients were evaluated over 2years. First, we assessed the evolution in time. Second, we tested the differences in mean scale scores of the PROMs between patients with a favourable and an unfavourable AO. One hundred seventy-five patients were included in the analysis. At baseline, unsatisfactory levels were already present for several scales. Most unsatisfactory PROMs improved up to 1year after RT. Complaints of fatigue increased at the start but decreased up to a lower level than that at baseline up to 1year after RT (mean difference (MD) 7.6, - 12.3, respectively). Cognitive functioning showed a small decrease at the start with no further significant decrease (MD - 4.73, - 0.21, respectively). Breast symptoms significantly increased during RT but decreased afterwards up to 2years after RT to lower values than those at baseline and were then considered satisfactory (MD 15.6, - 19.7, - 4.1, respectively). AO scored as PROM associated with BCCT.core and with the body image measures. The study suggests that quality of life and body image are temporarily impaired due to RT. Around one third of patients score their long-term AO as unfavourable. These results should be discussed with the patient and could help in the decision making of the treatment plan and in the clarification of the patient's expectations.

A Simple Algorithm for the Inframammary Fold Reconstruction, Balcony-Like Technique

The inframammary fold (IMF) is one of the most important landmarks that defines the breast region. Most of the current IMF reconstructive techniques are based on the creation of fibrotic structures to maintain the breast. We present a surgical technique of IMF reconstruction by the creation of a fascial flap underpinned by an anatomical evaluation of this structure and a simple algorithm to define the localization of the new IMF. Fifteen patients underwent our procedure of IMF reconstruction from 2004 to 2016. The patients were followed during at least 6 months after IMF reconstruction. This technique is based on the creation of a pectoralis major fascial flap fixed to the dermis by inverted resorbable sutures. The fascial flap represents a new ligament of the IMF reconstituting a physiological support. Cosmetic outcomes and stability over time were assessed. The long-term aesthetic outcome is optimal on all the patients treated with a natural shape and a good definition of the new IMF. There were no noted complications or revision surgery during the follow-up. Our technique consists of an anatomical reconstitution of IMF recreating a natural support “balcony-like” formed by the pectoralis fascia fixed to the dermis. This technique is useful to correct reconstructive or aesthetic procedures of the breast, with great cosmetic outcome and high reliability underpinned by the use of our position algorithm which is easy to use and enables a symmetrical position of the IMF.

254P - PROMs following breast-conserving therapy for breast cancer: Results from a prospective longitudinal monocentric study

Treatment of breast cancer includes many options and shared decision making is becoming standard practice. Within the context of treatment individualization, the omission of radiotherapy (RT) can be considered. It is thereby of great importance to correctly foresee the side effects attributed to RT. Data from longitudinal studies with contemporary techniques however are sparse. The purpose of the present study was to evaluate patient-reported outcome measures (PROMs) and long-term aesthetic outcome (AO) related to RT in the breast-conserving therapy (BCT) setting for breast cancer over time. Patients treated with BCT between April 2015 and April 2016 were prospectively included in the cohort. Evaluations were made at six time points: at baseline (before RT), during and at the end of RT, between 3 and 6 months, 1 year and 2 years after RT. AO was scored by the patient and by the BCCT.core software. Further PROMs were measured with the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire QLQ-C30/-BR23 and the Body Image after Breast Cancer Questionnaire BIBCQ. Patients were evaluated over 2 years. First, we assessed the evolution in time. Second, we tested the differences in mean scale scores of the PROMs between patients with a favourable and an unfavourable AO. One hundred seventy-five patients were included in the analysis. At baseline, unsatisfactory levels were already present for several scales. Most unsatisfactory PROMs improved up to 1 year after RT. Complaints of fatigue increased at the start but decreased up to a lower level than that at baseline up to 1 year after RT (mean difference (MD) 7.6, − 12.3, respectively). Cognitive functioning showed a small decrease at the start with no further significant decrease (MD − 4.73, − 0.21, respectively). Breast symptoms significantly increased during RT but decreased afterwards up to 2 years after RT to lower values than those at baseline and were then considered satisfactory (MD 15.6, − 19.7, − 4.1, respectively). AO scored as PROM associated with BCCT.core and with the body image measures. The study suggests that quality of life and body image are temporarily impaired due to RT. Around one third of patients score their long-term AO as unfavourable. These results should be discussed with the patient and could help in the decision making of the treatment plan and in the clarification of the patient’s expectations.

Abandoning the Supraorbital Bandeau in Anterior Craniosynostosis Repairs, for a Single-Segment Reconstruction.

Following correction of anterior sutural fusions, long-term forehead irregularities may arise. Based on the premise that frontal reconstructions using a seamless construct might produce better long-term aesthetic results, the supraorbital bandeau was abandoned for a single-piece frontal reconstruction. The purpose of this review was to compare outcomes and complications between children who underwent reconstruction with the traditional supraorbital bandeau and those who underwent reconstruction with a single bony segment. A retrospective sequential chart review was performed of all children undergoing anterior sutural fusion repairs to compare supraorbital bandeau to single-segment reconstructions. Length of surgery, blood loss, hospital stay, and complications were assessed. Aesthetic outcomes and reoperation rates were also examined. Over 10 years, 199 patients with anterior sutural fusions underwent correction: 124 with a single-piece frontal reconstruction and 75 with traditional supraorbital bandeaus. Outcome analyses revealed no significant differences between techniques with respect to blood loss, surgical times, complication rates, and hospital length of stay. A preliminary analysis suggested lower reoperation rates (0 percent versus 2.7 percent) and more favorable aesthetic rankings for those treated with a single segment, although the follow-up for this group was significantly shorter compared with those treated with a supraorbital bandeau (16 months versus 43 months). Abandoning the traditional supraorbital bandeau for a simplified single-segment frontal reconstruction has the potential to result in improved forehead aesthetics, although longer term evaluations are needed. This review suggests that this technical variation does not appear to be associated with longer surgical times, increased blood loss, or higher complication rates. Therapeutic, III.

Tongue reduction in Beckwith–Wiedemann syndrome: outcome and treatment algorithm

Beckwith–Wiedemann syndrome is a rare congenital overgrowth disorder with macroglossia being one of the cardinal symptoms. In pronounced cases, macroglossia can lead to airway obstruction, musculoskeletal alterations and functional deficits. Surgical tongue reduction is performed at varying ages and with different techniques. This study evaluated perioperative complications, as well as long-term aesthetic and functional outcomes, in a large cohort. A total of 68 patients, treated either surgically or conservatively, were included. Depending on the severity of macroglossia, patients were divided into three groups to determine the treatment algorithm. Complications after surgical tongue reduction were prolonged intubation and revision due to dehiscence or haematoma. In the long term, no patient suffered from impaired sense of taste or paresthesia, although the shape of the tongue was disproportional in 85%. With the present treatment algorithm, operative tongue reduction exerts a positive influence on skeletal, dentoalveolar and functional development with sufficient long-term outcome and high grade of satisfaction of the patients. Supportive therapy in an interdisciplinary centre is of fundamental importance for both surgical and conservative treatment.

Long-Term Esthetic Results of a Modified Technique of Bilateral Cleft Lip Repair

Purpose: To evaluate long-term esthetic results in the bilateral cleft lip repair by a modified technique characterized by prolabial self-elongation and orbicularis oris muscle reconstruction in one stage, using anthropometric measurements.Patients and Methods: Fourteen patients (8 were males and 6 were females) had their bilateral cleft lip and nasal deformity repaired simultaneously by modified technique characterized by prolabial self-elongation and orbicularis oris muscle reconstruction in one stage, during the period from 1999 to 2002. Direct and indirect anthropometry were applied to all patients to evaluate the long term esthetic results.Results: The long term esthetic results were satisfactory in all patients. There were no acute complications requiring re-surgery. In most patients, nasal length, nasal tip projection, columellar length, and upper lip shape were appropriate. Nasal tip protrusion, nasal width, upper lip height, and vermilion-mucosal height were within normal limit. The measurements were observed to be symmetrical; left and right measurement data were not significantly different. Conclusions: This modified technique is proved to be a valuable technique on the long term basis in repair of bilateral complete cleft lip which has its important impact on esthetic results.

Long-term outcomes of bilateral direct-to-implant breast reconstruction in women at high breast cancer risk

Introduction: Challenges of direct-to-implant breast reconstruction (BR) are to achieve sufficient implant coverage and lower pole projection. We assessed reoperation rates, long-term patient satisfaction and aesthetic outcome after direct-to-implant BR without acellular dermal matrix (ADM) in women with high breast cancer risk.Methods: Women who underwent bilateral skin or nipple-sparing mastectomy and immediate direct-to-implant BR between 1994 and 2006 completed a survey on reoperations and the Breast-Q Reconstruction questionnaire. Photographs taken during follow-up were rated for long-term aesthetic outcome (scale 1–10) by five plastic surgeons. Outcomes were compared between women who never underwent unanticipated reoperations after immediate BR and women who underwent one or more reoperations, adjusted for potential confounders using multivariable linear regression.Results: Of 143 women, 70 (49%) were never reoperated and 73 (51%) had undergone reoperations. Median follow-up was 12 years in both groups (range 7–17 and 6–19 years, respectively). Baseline characteristics were comparable except for history of prophylactic oophorectomy with 81% in the no-reoperations group versus 66% in the reoperated group (p = .03). Breast-Q scores were 59.7 ± 17.3 versus 58.0 ± 17.8 (p = .67) for ‘satisfaction with breasts’ and 71.1 ± 20.3 versus 68.1 ± 22.9 (p = .47) for ‘satisfaction with outcome’ in the no-reoperation versus reoperation group, respectively. Aesthetic outcome was scored 5.8 ± 1.1 in the no-reoperation group versus 5.3 ± 1.3 in the reoperation group (p = .01).Conclusions: The single-stage intent did not prevent unanticipated surgical reinterventions in 51% of the patients. Long-term patient satisfaction was reasonable and not affected by reoperations. Aesthetic outcome, however, was only poor to reasonable and scores were significantly lower in the reoperated group.